Walter Cronkite (00:00):

Today, the Supreme Court's ruling in Roe V. Wade legalized abortions. In this landmark case, the majority said that the decision to end a pregnancy belongs to the woman and her doctor, not the government.

President Ronald Regan (00:23):

I call America a good nation, a moral people to charitable but realistic consideration of the terrible cost of abortion on demand.

Rep. Henry Hyde (00:33):

Providing a constitutional right to an abortion does not mean society has to subsidize the exercise of that constitutional right.

Rep. John Lewis (00:43):

No government, federal, state, or local should tell a woman what she can or cannot do with her body.

Rep. Todd Akin (00:52):

America will say we are tired of abortion because it's so fundamentally un-American.

Sen. Barabara Boxer (00:56):

Why are women being singled out?

Rep. Gwen Moore (00:57):

[crosstalk 59]This bill is unconstitutional

President Donald Trump (00:58):

That cherishes innocent life-

Sen. Josh Hawley (01:14):

[crosstalk 74][crosstalk 74]This moral and social injustice that in 47 years has taken the lives of 61 million unborn.

Alice (01:35):

Growing up, it was me, my sister and my mom. And that's it. And we were the three Musketeers. I'm surrounded by strong women. And I think that really helped me deal with hard parts of my life. Having them there for me.

                  When I was in middle school, I think I had the big realization that no matter how many boycotts I did, no matter how many petitions I signed, no matter how long I stood outside of Macy's with an anti fur sign, I wasn't going to change the world. And so I acted out about things. I hung around with the wrong people. I did a lot of bad things, dropped out of high school, made some bad choices. So I guess being a rebel is good in some aspects, but I could have been a lot more successful, maybe if I hadn't really been a rebel.

                  My first abortion experience, I was 15 years old. I remember it like it was yesterday. I had sat my mom down and I feel like as soon as I sat her down, she knew exactly what I was going to say. So she said, "Okay, well, what are you going to do?" And I said, "I need to get rid of this."

                  So emotionally after my first abortion, I was fine. I was filled with relief. I had felt like I had been able to do something about a really big problem I had. The physical part was the worst. And it traumatized me to the point where when I had my son, 20 years later, I needed to have a C-section because I physically could not force myself to lie in a bed and put my legs in stirrups. I don't have any regrets about it. Do I wish I knew about abortion pills back then? Yes.

Kate Quinonez (03:37):

I guess what brought me to this work was my own personal experiences. I've had two abortions in my life. I've been a patient in this waiting room. We have an entire state depending on us, as well as regions of Kentucky and Ohio. A lot of the time, it feels like it falls on us singularly to hold the line in the state of West Virginia. Unfortunately, we have a lot of anti-abortion restrictions in place here. We provide abortion with suction aspiration and then medication abortion, it's done using two sets of medications.

                  So the first pill that patients get and they get here at the clinic is Mifeprex (mifepristone). And what this pill does, it blocks the body from producing progesterone, which is necessary to maintain a pregnancy. So the patient will take this here with the physician at the clinic. And then the patient will be sent home with a second set of pills called misoprostol. They're sent home with 800 micrograms. So four 200 microgram tablets, and they're directed to take this 24 hours after they take their mifepristone. And it causes the uterus to contract and expel the pregnancy. If a patient is between 10 and 11 weeks pregnant, we'll send them home with a second set of misoprostol that they'll be directed to take four hours after they take the first dose.

                  Medication abortion is extremely safe and extremely effective. It's shifting power a little bit more to individuals. Each decision to have an abortion is unique and the same goes for why people choose to have different methods of abortion. It's really not my place to say why a person would choose to self-manage their abortion. But what I can say is that restrictions that are currently in place, especially in states like West Virginia, that makes it harder for people to access abortion in a clinical setting.

Dr. Jamila Perritt (05:58):

Self-managed abortion really simply means someone is accessing abortion medication, usually but not always through non-traditional or non-medical roots. And so it's a broad story and it can be really complicated to understand. And it has everything to do with the way that abortion is unnecessarily, highly regulated in the United States.

Renee Bracey Sherman (06:23):

There are a number of issues within the abortion rights movement that can be kind of touchy or make people uncomfortable. Sometimes that's people having more than one abortion. Sometimes it's people having later abortions. And another one is self-managed abortion.

Shyrissa Dobbins (06:41):

So when we talk about self-managed abortion, we're completely removing the healthcare aspect from the termination of pregnancies. I think that scares a lot of people. I think the idea that each woman would be the expert in her experience is something that we're not ready to reckon with.

Alice (07:06):

So this is me when I was probably eight or nine months pregnant. And it's me and my husband. Oh my gosh, just looking, he's just so hot. I am so madly in love with my husband even all these years later. And he's not just incredibly sexy, he's a really good person, and he's a great dad. And I don't think I would've been able to find a better father for my son. I'm so glad that the one child I decided to have was with him. I look terrible, but he looks amazing.

                  The last abortion was after I was married, after I had my son, when I found out I was pregnant, I immediately knew I was going to need the pills and I would have to go to a clinic for them. So I went to a women's health center and they said they can do the surgical one. And they would give me all sorts of medication and make it comfortable. And I said, there's no way I can do that. And I said, you can find just about anything online. I bet I can find abortion pills.

Elisa Wells (08:34):

Francine and I do a lot of work internationally. When you're in that context in other countries, we were always asking the question, "Well, what do people do here? What do people do here for family planning?" So we always also asked the question, "Well, what about abortion?"

Francine Coeytaux (08:48):

As we were in these very rural areas, these parts of the Highlands of Ethiopia and parts of Ghana that you had to walk, we would go to the drug stores and the pharmacies and ask our colleagues from those countries to go in to find out what was available there. And we discovered that abortion pills were available.

Elisa Wells (09:09):

And here we are standing on the streets with abortion pills in our hand. And yet in the United States, we can't have access to them. Or if you can access the clinic, they're $800 for the service. And we asked the question, "Well, what would we find if we started surfing the web for abortion pills?"

Francine Coeytaux (09:29):

There were online sites that said they would ship them to you. They were coming mainly from India, but they said they would ship them to you. So then we were like, "Wow, this is interesting, let's find out more about that."

Elisa Wells (09:42):

I was a little bit skeptical about what we would find. But low and behold, the pills would come in the mail, they'd come right to my mailbox. So we sent the meds off to a lab to determine what was in the pills and how much of the active ingredient was actually present in the pills to see, are these the real thing and are they good quality? The results came back. And indeed they were the real thing. It was amazing. It was really amazing that these things were coming in the mail.

Alice (10:26):

I started my search for online abortion pills, and I ended up on the Plan C website and they had the Plan C report card. I had seen some websites offering kits of mifepristone and misoprostol. But it's the internet, you can't really believe everything and these things were $300. So I had to know that they were real and Plan C had actually ordered pills from all these different websites and they tested them for potency. They gave them a grade based on how quickly the shipping was, how potent they were, how much they were. And I'm looking at this chart and it's $400, $300. And then there's one that says it was either $72 or $92 or something. And I was like, what the heck? What is this? And so I clicked on it and it was Aid Access.

Francine Coeytaux (11:15):

So while we were putting up our report card, we had been working with groups overseas that we knew were making abortion pills available. And most famous one, and the one who'd done the most work was Women on Web.

Dr. Rebecca Gomperts (11:30):

In Guinea, in Africa, I was doing an internship, my last internship for my medical study. And I was working with a French doctor there. And there was a woman coming in. She had tried to induce an abortion with sticks. He saved her life. I did my first abortion ever in that hospital because I was assisting him because he was doing illegal abortions there. My first abortion was an illegal abortion. I had always been looking, what is the thing where I feel that I make the difference in the world? And it's just pills. We can send them to women. And that was 15 years ago.

                  It's exactly 15 years ago that Women on Web was founded. And the idea of Women on Web was always to help women in countries where abortion is legally restricted. And we've always said, but the US is such a rich country. I mean, it has all the resources. They should be able to solve their own problems. But in the last years, Women on Web is getting a lot of help emails from the US. And that what Aid Access is. It needed to be done and we looked for the way to do it.

Amy Merrill (12:47):

Aid Access comes on the scene and you have Rebecca Gomperts incredible activist doctor who's now doing these medically supported intakes, where she's taking people in through a very comprehensive survey. She's doing all of the different qualifying questions to be sure that they are a good fit for the online method and then she's shipping them the pills and offering a lot of support on the back end if anyone needs it, which we learned, usually they don't. And so that becomes the top of our report card is Aid Access.

Alice (13:17):

So this is the Aid Access homepage. It gives you options for, if you just want to know how to use the pills, what options are available in your area. To actually order the pills you need to click start consultation. And this is where they're going to ask you a whole bunch of medical questions to make sure that you qualify. I paid the donation and I got a tracking number within probably within 48 hours. And they emailed me and they said, "If you have any questions..." and they were super nice. And I got a tracking number and my pills were in India. And I was like, "Wow, okay, this is real." And I'm thinking, how do people not know about this?

                  They came with a prescription from Dr. Gomperts. So I took the mifepristone probably right away. And then within 24 hours, I came to my sister's house and I took the first four pills. And I think it took about six hours. And then the cramps got really bad. So I went to the toilet and everything just came out and the pain was just gone. And it was just this relief took the place of the pain. And that was that. And I emailed them and I said, "Thank you so much. You have no idea how much you are changing my life."

Renee Bracey Sherman (15:03):

I started in reproductive justice, really when I had an abortion, when I was 19. When I was volunteering with Access Reproductive Justice, I housed people who were traveling for their abortions, drove them to their appointments, held their hands. I trained as an abortion doula. And all of that work really showed me how I was lucky in my experience, but also all of the oppressions and challenges and barriers that I experienced and that others are experiencing and how they're systemic, right? They may have to wait longer to get an abortion. They may have to travel further. All of these things keep increasing. It makes it really, really difficult for them to be able to get the care that they need when they want it.

Ari (15:53):

I found out I was pregnant my second year of undergrad. I was identifying as a cisgender woman. And that was the first time I really admitted that I didn't feel like a woman. I thought about going to a clinic, but there were some substantial barriers in my way. And I knew I couldn't afford it.

Renee Bracey Sherman (16:18):

People have always been interested in being able to control their own fertility and have used a lot of different methods. And I think it's important to recognize that self-managed abortion is part of our legacy. It always has been, and it always will be.

Dr. Jamila Perritt (16:36):

We definitely see that individuals who are historically marginalized from care for any number of reasons: logistical barriers, transportation, lack of paid leave, lack of childcare. There are lots of things that impact the ability of individuals to get the care that they need in a timely fashion.

Shyrissa Dobbins (16:55):

Self-managed abortion is really the only option to terminate a pregnancy without spending, in some jurisdictions, days to get an abortion. So the idea that every woman has access to safe abortion, I think is false, particularly abortion in the clinical sense where you go to a physician to get these pills.

Ari (17:18):

When I had my abortion, I feel like it was before the two waves of telemedicine and open communication about self-managed abortion. So a lot of what I was finding were personal narratives of people who had said how they terminated their pregnancies. I chose a more holistic method and I was fortunate enough that it worked for me. I think emotionally, it was just that loneliness. I felt like I was the only one who had ever gone through this. And I knew rationally that wasn't the case, but going through it alone was hard. That's really my only regret.

Renee Bracey Sherman (18:16):

I think it's super important to have accurate, open information about self-managing abortions, methods, pills, all of those things out in the open. Because we know people are going to self-manage their abortions. They have since the beginning of time, they always will.

Francine Coeytaux (18:35):

When we started five years ago, it was a theoretical platform. It was a platform, "Oh, you need to know that in other countries is possible, but in our country, it's not for these and these and these reasons." We have moved so far in five years.

Renee Bracey Sherman (18:51):

Medication abortion pills have been critical all around the world to helping people access abortion in extremely criminalized, overregulated communities and countries.

Ari (19:04):

If I had had the opportunity to use a service as simple as ordering medications online and having it shipped to me when I had my abortion way back when, I may have been more inclined to choose that option. So I think it's incredible that this exists now.

Alice (19:25):

When you're pregnant, you feel like you've lost any semblance of control over your life. You're constantly beating yourself up because how did you let this happen? And then how are other people going to see it? How is your significant other going to see it? And then here comes this pill that just makes it all go away safely. And it was definitely eyeopening.

Christopher Purdy (20:02):

The reason I got interested in this, I think it was partly in the DNA, because my father worked for Planned Parenthood. So I think the apple doesn't fall too far from the tree. DKT markets and sells the IPAS MVA kit in about a hundred countries around the world. We also sell the abortion pill. Last year, we sold about 5 million of the combi-packs and about 19 million misoprostol pills. So that's a lot.

                  I would say the abortion pills are the technology that has enabled self management of abortion. It's the linchpin.

Renee Bracey Sherman (20:46):

A lot of people when they're talking about abortion pills, they mean mifepristone plus the four misoprostol pills. And that concoction came in the late 1980s, 1988, through a French pharmaceutical company. And that's actually not where the story begins. I think it's really important that we talk about all the folks whose ingenuity really contributed to it. And for the abortion pills, that's Brazilian activists.

Farah Diaz-Tello (21:22):

In Brazil, where abortion is almost entirely criminalized and inaccessible, in the 1980s women, by reading the contraindications on the cytotec label discovered that it would cause miscarriages. So public health researchers looked into what was happening and they discovered that women had found out for themselves ways to have safe, self-managed abortions. Mifepristone was first developed in the 1980s in France. And when it was first discovered, it was touted as the moral property of women. This was something that was immediately understood as a game changer. It was approved in the early 2000s in the United States, and almost immediately it became a political football, such that it was never fully able to realize its promise.

Rep. Ron Wyden (22:06):

he subcommittee's focus today will be the French drug, RU-486, a pharmaceutical with both abortifacient and non-abortifacient properties.

Unnamed Medical Expert (22:16):

Both medical scientists and pharmaceutical companies are intimidated by this climate of federal governmental repressions.

Unnamed Anti-Abortion Activist (22:23):

We absolutely oppose RU-486 being tested for abortion.

Alice (22:27):

Once women can just have abortions when they want on their own terms, that would just be a mind blowing concept for a lot of people in Congress. A lot of people in the organizations that provide abortions in this country. And I think that they've been given the power for so long. There's no way they're okay with just letting the information out there.

Christopher Purdy (22:54):

The REMS is a government regulation that fundamentally impacts on how those drugs can be administered and provided. It basically turns mifepristone into the same way that you would treat an opiate. You can't buy it over the counter, it has to be prescribed, it has to be administered by a doctor. It puts a lot of restrictions on the way that the drug can be accessed.

Dr. Jamila Perritt (23:16):

So if we think about the risk of complication for something like Tylenol, for example, or ibuprofen, that risk is much higher than either of these medications. And both of those medications, you can pick up in your local drug store without a prescription, without seeing a healthcare provider, unless you absolutely want to. Not to mention things like Viagra and other medications that really require prescription, but are still less highly regulated than this medication.

Christopher Purdy (23:47):

So there are many countries in the world like Ethiopia, like India, where a woman can walk into a pharmacy and ask for the abortion pills and they can buy those directly over the counter and the pharmacist will give them to her.

Renee Bracey Sherman (24:02):

Really, what's keeping it from being able to go into people's hands freely is simply abortion stigma and outdated medically unnecessary protocols. That's it. The government is what's standing in the way. And the government is what's always stood in the way of access to abortion care, particularly medication abortion pills.

Ari (24:23):

When it comes to the criminalization of abortion, I think there is always that fear that even though I had my abortion years and years and years ago, that there will be a loophole in some law, especially in the conservative state that I live in, that might endanger me. And we shouldn't have to live that way. It's not fair.

Dr. Jamila Perritt (24:58):

I love to talk about safety around self-managed abortion. I think it's an important concept because I think that the place that most people go to is medical safety. And that's an easy answer. Yes, these medications are safe. We have a lot of evidence to support that. That's an unequivocal, that's the easy response. But safety really, to me, is more than medical risk. Safety, in this case in particular is a legal risk. Because these medications are so highly regulated, the thing that makes them unsafe, that makes self-manage abortion unsafe is the legal risk that people are put in because of their attempt to manage their own care.

Farah Diaz-Tello (25:38):

The vast majority of people who self-managed their abortions never come to the attention of the medical system. They never come to the attention of the legal system because they manage to have a safe and effective self-managed abortion. That said, there is no way that a person can completely insulate themselves from legal risk, because it is so subject to the whims of prosecutors. People who are marginalized by our society, whether that is on the basis of race or class or their gender identity are more likely to be swept into criminalization for a couple of different reasons. The first is that they may be more likely to seek a self-managed abortion. The other reason is because those communities are over-surveilled and over-policed.

                  We want people to be able to have the information they need to have self-managed abortions that are safe and that they don't have to fear arrest for the decisions they make about their own bodies. We want everybody to be able to receive the care that's right for them. And that respects their dignity, whether that's in a clinic or whether that's self-managed or whether that's something in between. And this has been something that has been important during the pandemic, because people may not know that they have access to telemedicine abortion.

Alice (26:57):

When I ordered from Aid Access, it was a telehealth appointment. It was an online consultation. I answered questions, medical questions, a doctor reviewed them and said, "Okay, she qualifies for this." So I think COVID has made corporations, the medical community and all sorts of industries, realize a lot more can be done remotely than we ever thought possible.

Dr. Meera Shah (27:23):

I am a family medicine physician by training, and I had an incredible mentor who really introduced the idea of reproductive health to me. I've really dedicated my career to figuring out ways to optimize access to abortion care. In healthcare, we've been talking about telehealth and how great it would be for years and years and years. COVID-19, the pandemic did end up being the catalyst, the push that we needed to really realize how impactful it can be in terms of accessing patients. I had this one patient who was an emergency responder and she was actually in her ambulance. And she and I were speaking via the telehealth video conference. And I provided her with healthcare. And then she came by, picked up the medication abortion pills and went on to continue her shift.

Dr. Jamila Perritt (28:30):

Telehealth seems like a wonderful option. And for some people it is. But legislative restrictions on abortion through telehealth has been a limiting option. We also know that the digital divide is great. And so there are many individuals and many entire communities who don't have the same access to telehealth resources.

Dr. Meera Shah (28:50):

I am very hopeful we're going to see some changes. I have so many colleagues who were doing a lot of research to gather the data and just show how safe it is to either mail mifepristone to the patient, or be able to at least send it to the pharmacy. And so I'm really excited to see what that research reveals and how that's going to impact policy.

Francine Coeytaux (29:24):

Yeah.

Amy Merrill (29:27):

Online pharmacies appearing by cost then ship time.

                  So as we saw the proliferation of these different options, we realized that we needed something more than a static report card. So we have a guide to pills, which is a directory covering all 50 states and showcasing exactly what's available at this moment, everything from medically supported telemedicine options, all the way to self-managed options and online pharmacies.

Francine Coeytaux (30:01):

Yep. As Elisa keeps saying, we finally got to the 21st-century abortion.

Christopher Purdy (30:07):

Well, I mean, I thought the title of your documentary is an interesting one, right? Add To Cart. Will there be a day where that is happening at scale? Will there be a day where that's possible? Probably. Probably that's coming

Dr. Jamila Perritt (30:26):

Self-manage abortion is not in lieu of providing abortions in a clinical space. We need both. We need both for people who want it. And we need both for those who need it.

Renee Bracey Sherman (30:36):

I think the way the reproductive health rights and justice movement should approach advocacy around self-managed abortion is unapologetically. It's about whether or not they get to control our lives. And whether we get to actually decide if, when, and how to grow our families. Rarely, are we actually at the discussion table. And I think that's why storytelling is really important because as we're sharing our stories, we are demanding to be at this table.

Ari (31:12):

I'd say my abortion, honestly, was a catalyst in changing a lot of areas of my life. I'm out here as a non-binary person. I'm out here as a queer person. I'm unapologetically in love with my partner. And I'm just out here advocating that abortion can look a million different ways. And I have this phenomenal community of people that I've shared my abortion story with and who have shared theirs with me. And I never have to be alone like that again.

Alice (31:51):

I'd always been supportive of abortion rights, but this kind of brought it to a whole new level and it just really put into perspective what exactly bodily autonomy really means. Is it being given choices that you have to choose between, a couple options, or is it given the freedom to do what you want with your body? And I was able to do that. When I started being vocal about my self-managed abortion online, I was contacted by women all over the world. They would tell me their abortion stories. So I decided to go back to school for my Bachelor's in Public Health and maybe work with Marie Stopes International or some other outreach organization.

Director (32:43):

Why did you decide to do this documentary?

Alice (32:52):

Because anytime I can talk about abortion, I jump at the chance. The more it's talked about, the more the word is said, it lessens the stigma just a little bit. And that's probably the biggest thing we can do to help pregnant people and access to abortion is just to get rid of that stigma. It's not a bad word. It's not taboo. It's not a dirty little secret. It's part of being a human. And if I can just reach one woman and make her feel like it's okay, it's worth it.

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